DNR

Do you really need one?

by Jason ValaVanis, CFP

I generally refrain from writing about non-financial issues in these articles.  I guess it depends on how we look at life-planning concerns and whether or not it is connected to finances.  A DNR order is a written and signed document placed into a patient's file for the doctor and/or hospital.  It stands for "Do Not Resuscitate".  Resuscitation is defined as Cardio-Pulmonary Resuscitation, or "CPR".  This document is often misused and misunderstood.  Its use must be carefully examined.

My practice generally focuses on six key areas;  Personal financial planning,  investment planning, estate planning, insurance, tax guidance, & retirement matters.  Having a discussion on whether or not to  be resuscitated doesn't fit too well into any of these categories, so bear with me.  If you are dead because a DNR was inappropriately used, it just may be a bad financial move.    By in large, if you are unnecessarily dead, you no longer have access to your retirement funds, in my opinion.  This is how I see it and I am sticking to my guns.

NECESSARY?

I have met seniors that have included a DNR in their overall estate plan.  Yes, I sometimes see it snuggled inside their estate plan folder as if it is a crucial document.  Often, these very same seniors are not chronically ill and could live another 20 years.  Herein, lies the problem.

FLAT LINER

A DNR is not for everyone.  In fact, a DNR should only be drafted and provided to the healthcare community if you are suffering from a disease that is very debilitating, causes immense pain and could cause your death at any time.  If you lapse into unconsciousness and your vitals flat line and you have a DNR in place, life-saving resuscitation will not be given and you will be left to die.  A DNR should only be drafted if you really do not want to continue suffering with the disease.

ALTERNATIVES 

Other treatments (for example; antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. Depending on the person's condition, these other treatments are usually more likely to be successful than CPR. Treatment that keeps the person free of pain and comfortable (called palliative care) should always be given.

BAD IDEA? 

Imagine this; You really have no chronically debilitating disease and you are in the hospital for a routine surgery and have submitted your DNR upon admission.  While in the hospital, you suffer a heart attack and collapse.  The hospital is required to abide by your DNR and let you die.  In all reality, you could have been resuscitated with CPR and eventually heal with treatment and live another 10 or more years.  This happens all the time, and it can be avoided.  Some attorneys will include a DNR in the composite estate plan without proper consideration.  Many seniors think it is necessary to submit a DNR to the hospital every time they are admitted.

LIVING WILL 

The critical document that most often needs to be drafted and submitted is the Living Will.  A Living Will willfully and voluntarily makes known your desire that your dying not be artificially prolonged under the following circumstances:  You have a terminal condition; or you have an end-stage condition; or you are in a persistent vegetative state.  Generally, if your attending physician has determined that there is no reasonable medical probability of your recovery from such condition, your Living Will directs that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong, artificially, the process of dying.  This allows you to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide you with comfort care or alleviate pain.  This is the document most seniors need.

THINK TWICE

Arbitrarily drafting a DNR may leave you permanently dead when you really wanted to be temporarily alive (10 or 20 years more).  A DNR will force the hospital or rescue team to abstain from saving your life, even if you may not want to get promoted to heaven just yet.  I know this subject is a bit morbid and not really a money issue, but you must agree with me that staying alive and enjoying your savings could fit very well into a first-class financial plan.  If you have a DNR in place - think twice!